The glyburide really seems to be working. I've been well under 95 every morning, except the morning after I forgot my glyburide and had a fasting blood glucose level of 104.
Despite the fact that my fasting number is so much lower, I quickly discovered that I still need to go for a walk after breakfast to keep my post-breakfast reading under 130, otherwise it ends up slightly elevated. But a 10-12 minute walk will generally keep it under 120.
The rest of my post-meal readings are consistently under 130 (with a few exceptions I have posted about previously), so I am able to keep them in check through diet and exercise. It really seems to be the mornings I have the most trouble with.
I want to ask my OB at my next visit (Sept 4) when I should stop taking the glyburide. The nurse indicated I would take it until I delivered, but not after since you can't take it while breastfeeding. But the information that came with the prescription says you should stop taking it 2 weeks before your anticipated due date so it won't show up in your breast milk. I might be taking a low enough dose that it's not a concern, but I do want to verify since I intend to breastfeed exclusively.
Tuesday, August 25, 2009
Thursday, August 20, 2009
Looking on the bright side
On the tough days, it is easy to think about the downside of having gestational diabetes. But this morning, during my morning walk, I was thinking about the upside.
For one thing, I'm eating better for the baby than I had been. The lack of appetite that persisted after the first trimester had me eating a lot of cereal and PB&J sandwiches. I'm eating a better variety of foods now.
I'm also learning healthy eating habits that I think will stay with me and help me ward off Type II diabetes, such as eating smaller meals and eating snacks in between, as well as combining proteins with carbs.
I'm gaining less weight than I would otherwise. I started this pregnancy 10 pounds heavier than my last pregnancy and was worried about ending up 10 pounds heavier at the end than at the end of my last pregnancy. But since I started the diet and exercise, my weight gain has slowed and I'm almost hopeful that I will plateau and end up right around where I did last time.
And the other thing I'm happy about is that we are talking to our neighbors more now that we are out walking every evening (and I'm out every morning). The evenings here have been unseasonably cool and pleasant and we often see neighbors out in their yards or walking their dogs and stop to chat. We've even met some new neighbors, including a couple that lives 2 houses away that we never manged to introduce ourselves to in the 4 years we've been here.
For one thing, I'm eating better for the baby than I had been. The lack of appetite that persisted after the first trimester had me eating a lot of cereal and PB&J sandwiches. I'm eating a better variety of foods now.
I'm also learning healthy eating habits that I think will stay with me and help me ward off Type II diabetes, such as eating smaller meals and eating snacks in between, as well as combining proteins with carbs.
I'm gaining less weight than I would otherwise. I started this pregnancy 10 pounds heavier than my last pregnancy and was worried about ending up 10 pounds heavier at the end than at the end of my last pregnancy. But since I started the diet and exercise, my weight gain has slowed and I'm almost hopeful that I will plateau and end up right around where I did last time.
And the other thing I'm happy about is that we are talking to our neighbors more now that we are out walking every evening (and I'm out every morning). The evenings here have been unseasonably cool and pleasant and we often see neighbors out in their yards or walking their dogs and stop to chat. We've even met some new neighbors, including a couple that lives 2 houses away that we never manged to introduce ourselves to in the 4 years we've been here.
Complications
Since starting the glyburide, I've been doing much better with my glucose levels. My fasting blood glucose has been 90 or below every day since I starting the glyburide, usually around 85. And the few times I've gone over 130 after a meal, it's never been over 135 (with one exception) and I could usually pinpoint something in my diet (or lack of exercise) that caused it.
The one exception was Monday night. That afternoon, I noticed a contraction just before 3pm. I thought it was a BH contraction at first, but realized it was a little painful. Only about a 3 on a scale of 1 to 10, but the BH contractions have never been painful. I was working at the computer and jotted down the time. Twelve minutes later, I had another one. And another 12 minutes after that. I knew that 6 contractions in an hour, even BH contractions, warranted a call to the OB, and if they continued at 12 minutes apart, that would be 6 within an hour. The next came 10 minutes later, but was milder. And another mild one came 10 minutes after that. By then, my son woke up and I couldn't keep track. But I called my husband to come home and called my OB's office. The nurse called back and said to go to triage.
I spent 2 1/2 hours at triage, being monitored. It was over the dinner hour and I asked if they had food since I was due for a meal and I had gestational diabetes. They brought me a turkey sandwich with an apple and some kind of sugar-free gel dessert. I ate the whole sandwich although I suspected it had more carbs than the bread I normally eat, but I only ate half the apple.
Immediately before I ate, they also gave me a shot of terbutaline to stop the contractions. One hour after I started eating, my blood sugar was 152. That was pretty high even for a higher carb bread. I also hadn't gone for a walk, obviously, but considering that my post-dinner blood sugar when I do take a walk is in the low 100s or even mid-90s, I suspect the terbutaline had something to do with it.
When they released me, they said no exercise or lifting until my OB cleared me. This worried me since the last time I skipped my post-meal walks, my blood sugar was too high. Fortunately, I got ahold of my OB on Tuesday and he cleared me to resume normal activities. The contractions hadn't opened or thinned my cervix and the fetal fibronectin test they did came back negative, meaning I was unlikely to deliver in the next 2 week. He said controlling the gestational diabetes was more important. So although I skipped my morning walk on Tuesday (and had a blood sugar of 131 after breakfast), I resumed my walks that night and have been doing OK ever since.
The one exception was Monday night. That afternoon, I noticed a contraction just before 3pm. I thought it was a BH contraction at first, but realized it was a little painful. Only about a 3 on a scale of 1 to 10, but the BH contractions have never been painful. I was working at the computer and jotted down the time. Twelve minutes later, I had another one. And another 12 minutes after that. I knew that 6 contractions in an hour, even BH contractions, warranted a call to the OB, and if they continued at 12 minutes apart, that would be 6 within an hour. The next came 10 minutes later, but was milder. And another mild one came 10 minutes after that. By then, my son woke up and I couldn't keep track. But I called my husband to come home and called my OB's office. The nurse called back and said to go to triage.
I spent 2 1/2 hours at triage, being monitored. It was over the dinner hour and I asked if they had food since I was due for a meal and I had gestational diabetes. They brought me a turkey sandwich with an apple and some kind of sugar-free gel dessert. I ate the whole sandwich although I suspected it had more carbs than the bread I normally eat, but I only ate half the apple.
Immediately before I ate, they also gave me a shot of terbutaline to stop the contractions. One hour after I started eating, my blood sugar was 152. That was pretty high even for a higher carb bread. I also hadn't gone for a walk, obviously, but considering that my post-dinner blood sugar when I do take a walk is in the low 100s or even mid-90s, I suspect the terbutaline had something to do with it.
When they released me, they said no exercise or lifting until my OB cleared me. This worried me since the last time I skipped my post-meal walks, my blood sugar was too high. Fortunately, I got ahold of my OB on Tuesday and he cleared me to resume normal activities. The contractions hadn't opened or thinned my cervix and the fetal fibronectin test they did came back negative, meaning I was unlikely to deliver in the next 2 week. He said controlling the gestational diabetes was more important. So although I skipped my morning walk on Tuesday (and had a blood sugar of 131 after breakfast), I resumed my walks that night and have been doing OK ever since.
Thursday, August 13, 2009
First dose of glyburide
The glyburide prescription didn't get called in until Wednesday. On Tuesday, my fasting blood sugar was 93 and the rest of the day I was under the 130 post-meal limit. So I thought that if my fasting blood sugar on Wednesday was still under 95, maybe I could delay starting glyburide for another day and see how I did.
Tuesday night, my post-dinner blood sugar was 99. I had the same bed-time snack as the night before (peanut butter and a tsp of low sugar jam on a slice of wheat bread with a glass of milk) at the same time as the night before (9:35pm). Wednesday morning, I tested my blood sugar at 7am, the same time as I tested on Tuesday. My reading was 99. Quite a bit higher than the previous day and several points over the limit. I guess there really isn't anything I can do about it.
So Wednesday I picked up the glyburide. I was reading the info that came with it and noticed that it said to discontinue use 2 weeks prior to your expected due date if you plan to breastfeed. The nurse had told me I would take it up until I deliver, but not after I deliver since you can't take it if you are breastfeeding. Which makes me wonder how long it stays in your blood. I'll have to ask my OB at my next appointment since I definitely plan to breastfeed.
Last night with my night time snack, I took 2.5 mg of glyburide. I woke up several times last night to pee, but didn't notice any signs of hypoglycemia. Although it might be hard to tell when you are half asleep. My fasting blood sugar this morning was 84. After breakfast, it was 116. I had the same breakfast as yesterday (1 whole grain waffle (12.5 g of carbs) with peanut butter and a side of cottage cheese and coffee) and yesterday my blood sugar was 124. And that was after a nearly 20 minute walk! Today, I didn't get out for my walk, partly because I was tired and partly because Thom was working from home and I didn't have the energy to take Aaron with me. So having a lower baseline really helps in the morning.
Tuesday night, my post-dinner blood sugar was 99. I had the same bed-time snack as the night before (peanut butter and a tsp of low sugar jam on a slice of wheat bread with a glass of milk) at the same time as the night before (9:35pm). Wednesday morning, I tested my blood sugar at 7am, the same time as I tested on Tuesday. My reading was 99. Quite a bit higher than the previous day and several points over the limit. I guess there really isn't anything I can do about it.
So Wednesday I picked up the glyburide. I was reading the info that came with it and noticed that it said to discontinue use 2 weeks prior to your expected due date if you plan to breastfeed. The nurse had told me I would take it up until I deliver, but not after I deliver since you can't take it if you are breastfeeding. Which makes me wonder how long it stays in your blood. I'll have to ask my OB at my next appointment since I definitely plan to breastfeed.
Last night with my night time snack, I took 2.5 mg of glyburide. I woke up several times last night to pee, but didn't notice any signs of hypoglycemia. Although it might be hard to tell when you are half asleep. My fasting blood sugar this morning was 84. After breakfast, it was 116. I had the same breakfast as yesterday (1 whole grain waffle (12.5 g of carbs) with peanut butter and a side of cottage cheese and coffee) and yesterday my blood sugar was 124. And that was after a nearly 20 minute walk! Today, I didn't get out for my walk, partly because I was tired and partly because Thom was working from home and I didn't have the energy to take Aaron with me. So having a lower baseline really helps in the morning.
Tuesday, August 11, 2009
Glyburide
I saw the dietitian and the nurse this morning after having trouble controlling my blood sugar last week. The last 3 mornings my fasting levels have been 95 or under and my post-meal levels have mostly been OK the last two days. But looking back over the week, my averages were too high. And they pointed out that even when my fasting levels weren't high (prior to the triage incident and in the last 3 days) they are still hovering right around 95.
I had really hoped to control my blood sugar through diet and exercise, in part because my OB thought I would be able to, but mostly because I feel that is best for me and the baby. So I was disappointed when they decided to start me on medication. I had hoped that since I was doing better since I started exercising again that we could modify my diet a little first. But the dietitian didn't see that I was eating a lot of carbs and she feels that the high levels are most likely due to pregnancy hormones. Plus the fasting level which seemed to be their highest concern, along with my post-breakfast levels, which could be high due to a higher fasting level, seems to be harder to control with exercise and diet. And she said she didn't want me to starve myself by cutting back my carbs even more. And some mornings, I was so hungry, I felt like I was starving myself.
The medication is Glyburide. The nurse explained that it makes the pancreas pump out a little more insulin and that it doesn't cross the placenta. I can't take it when I'm breast feeding, though, so I won't take it past the delivery. They are starting me on 2.5 mg, to be taken with my night time snack.
They started to talk about my high post-lunch readings, but when I pointed out that it seemed to be higher the times I had fruit, we decided I would avoid fruit at lunch time for now and see how it goes. The dietitian even suggested adding fruit to my dinner (as extra carbs) since my post-dinner readings are so good (usually 110 or less, often under 100 when I go for a walk). I do have fruit with cottage cheese every day for my afternoon snack, so I might just stick with that for now.
They warned me about hypoglycemia - low blood sugar - and that if I woke up at night with any of the symptoms, I should test my blood sugar. If it is below 60, I should have a fast-acting carbohydrate, like 1/2 cup of juice, then retest my blood after 20 minutes (I think that is right, but I have to double-check the time). If that happens 2 nights in a row or if my fasting blood sugar is under 60 2 mornings in a row, I should call and they could cut my dose back to 1.25 mg, but she didn't think I'd have a problem. 2.5 mg is a pretty low dose, apparently.
I'm not thrilled about it, but I want to do whatever is best for the baby. And maybe it will mean I have an easier time controlling my blood sugar after breakfast and after lunch. I'm just worried that I'll end up putting a little sugar in my coffee or skipping my morning walk if the glyburide is doing all the work.
I had really hoped to control my blood sugar through diet and exercise, in part because my OB thought I would be able to, but mostly because I feel that is best for me and the baby. So I was disappointed when they decided to start me on medication. I had hoped that since I was doing better since I started exercising again that we could modify my diet a little first. But the dietitian didn't see that I was eating a lot of carbs and she feels that the high levels are most likely due to pregnancy hormones. Plus the fasting level which seemed to be their highest concern, along with my post-breakfast levels, which could be high due to a higher fasting level, seems to be harder to control with exercise and diet. And she said she didn't want me to starve myself by cutting back my carbs even more. And some mornings, I was so hungry, I felt like I was starving myself.
The medication is Glyburide. The nurse explained that it makes the pancreas pump out a little more insulin and that it doesn't cross the placenta. I can't take it when I'm breast feeding, though, so I won't take it past the delivery. They are starting me on 2.5 mg, to be taken with my night time snack.
They started to talk about my high post-lunch readings, but when I pointed out that it seemed to be higher the times I had fruit, we decided I would avoid fruit at lunch time for now and see how it goes. The dietitian even suggested adding fruit to my dinner (as extra carbs) since my post-dinner readings are so good (usually 110 or less, often under 100 when I go for a walk). I do have fruit with cottage cheese every day for my afternoon snack, so I might just stick with that for now.
They warned me about hypoglycemia - low blood sugar - and that if I woke up at night with any of the symptoms, I should test my blood sugar. If it is below 60, I should have a fast-acting carbohydrate, like 1/2 cup of juice, then retest my blood after 20 minutes (I think that is right, but I have to double-check the time). If that happens 2 nights in a row or if my fasting blood sugar is under 60 2 mornings in a row, I should call and they could cut my dose back to 1.25 mg, but she didn't think I'd have a problem. 2.5 mg is a pretty low dose, apparently.
I'm not thrilled about it, but I want to do whatever is best for the baby. And maybe it will mean I have an easier time controlling my blood sugar after breakfast and after lunch. I'm just worried that I'll end up putting a little sugar in my coffee or skipping my morning walk if the glyburide is doing all the work.
Discouragement
The last week or so has been discouraging. My blood sugar readings were frequently too high even after I started exercising again. And although the first couple of weeks on the diet weren't too bad, in the last 10 days, I've had a couple of days where I really, really craved something I couldn't have. Something as simple as an extra glass of milk or some juice or a bite of Thom's ice cream. It felt depressing to be avoiding those things and still have high blood sugar.
I did feel like I cheated a little. Although I was told I could have angel food cake and had had some previously without a problem, I had some last week when I had family over for dinner. With unsweetened peaches and just slightly sweetened home made whip cream. It would have been OK, but that was when I was just getting back into exercising and knew I was having trouble keeping my blood sugar under control.
Previously, I had been consistently having the same bedtime snack of 1/2 a peanut butter sandwich with a teaspoon of reduced sugar jam and a glass of milk. That snack had seemed to keep my fasting glucose levels in check. But not only did I have the angel food cake for my night time snack that Tuesday, I varied my night time snack several nights in a row because I just wanted something different. But after having high fasting scores several days in a row, I went back to my peanut butter sandwiches. A different week it might have been OK, but I probably shouldn't have changed it the week I was struggling to keep my blood sugar under control.
I also had several days where I just felt hungry all day. Or I'd eat a snack and feel full for only 30 minutes. Those were tough days. I could have had an extra low-carb snack (and once or twice I did), but mostly I didn't feel like eating anything I could have had.
I think the most discouraging day was the day I had a fasting level of 100 and even though I only had one piece of Trader Joe's french toast (15 g carbs) with peanut butter and went for an 18 minute walk, my post-breakfast reading was 136. I had never had a high post-breakfast level after going for a walk. That was disappointing.
Overall, I feel good about how I'm doing with the diet and the amount I am exercising. And most days the diet is tolerable. But some days are definitely harder than others.
I did feel like I cheated a little. Although I was told I could have angel food cake and had had some previously without a problem, I had some last week when I had family over for dinner. With unsweetened peaches and just slightly sweetened home made whip cream. It would have been OK, but that was when I was just getting back into exercising and knew I was having trouble keeping my blood sugar under control.
Previously, I had been consistently having the same bedtime snack of 1/2 a peanut butter sandwich with a teaspoon of reduced sugar jam and a glass of milk. That snack had seemed to keep my fasting glucose levels in check. But not only did I have the angel food cake for my night time snack that Tuesday, I varied my night time snack several nights in a row because I just wanted something different. But after having high fasting scores several days in a row, I went back to my peanut butter sandwiches. A different week it might have been OK, but I probably shouldn't have changed it the week I was struggling to keep my blood sugar under control.
I also had several days where I just felt hungry all day. Or I'd eat a snack and feel full for only 30 minutes. Those were tough days. I could have had an extra low-carb snack (and once or twice I did), but mostly I didn't feel like eating anything I could have had.
I think the most discouraging day was the day I had a fasting level of 100 and even though I only had one piece of Trader Joe's french toast (15 g carbs) with peanut butter and went for an 18 minute walk, my post-breakfast reading was 136. I had never had a high post-breakfast level after going for a walk. That was disappointing.
Overall, I feel good about how I'm doing with the diet and the amount I am exercising. And most days the diet is tolerable. But some days are definitely harder than others.
Excercise Part III
I wrote twice before about the positive effect that walking has had on my blood sugar. It was made clear to me again when I stopped walking completely for 2 days last week.
About 10 days ago, on a Saturday night, I noticed some light spotting. I had spotting later in my first pregnancy, too, so I tried not to worry too much. But an hour later, I started having menstrual-like cramps. The information my OB had given me on preterm labor symptoms include menstrual-like cramps and spotting, so to be safe I called his office. (My sister had preterm labor with her second pregnancy. Fortunately they caught it in time and put her on bed rest. But it makes me more cautious.) I spoke with a nurse practitioner that night and he suggested I go down to triage (which is basically the ER for pregnant women at the hospital where I'm delivering).
After monitoring the baby and my contractions for about an hour, they cleared me to go home. Although I'd noticed some BH contractions on the drive down, they had calmed while I was down there and the baby sounded fine. They suggested I take it easier, but didn't restrict any particular activity (aside from sex). Just to be on the safe side, though, I didn't do my morning or evening walk on Sunday. My blood sugar readings were still OK on Sunday.
But Monday, I was still spotting and again didn't go on my morning walk. That's when I started having higher blood sugar readings. Since the spotting was going away, I went on a short walk on Tuesday after breakfast. After a couple of days of not not walking, even my fasting levels were creeping up. They had been in the low to mid-90s. Three days in a row they were high 90s and I had one 100.
Gradually, by this last weekend, I was doing my full morning and evening walks and the last few days my numbers have been more like they used to be before the whole triage incident. It seems like there is a cumulative effect with the exercise - that first day of no exercise my numbers were still OK. And it took several days of resuming exercise before my numbers started to go down.
But since I had more than 6 post-meal levels above 130 in a week and more than 3 high fasting levels, I had to go see the dietitian again, a week earlier than scheduled.
About 10 days ago, on a Saturday night, I noticed some light spotting. I had spotting later in my first pregnancy, too, so I tried not to worry too much. But an hour later, I started having menstrual-like cramps. The information my OB had given me on preterm labor symptoms include menstrual-like cramps and spotting, so to be safe I called his office. (My sister had preterm labor with her second pregnancy. Fortunately they caught it in time and put her on bed rest. But it makes me more cautious.) I spoke with a nurse practitioner that night and he suggested I go down to triage (which is basically the ER for pregnant women at the hospital where I'm delivering).
After monitoring the baby and my contractions for about an hour, they cleared me to go home. Although I'd noticed some BH contractions on the drive down, they had calmed while I was down there and the baby sounded fine. They suggested I take it easier, but didn't restrict any particular activity (aside from sex). Just to be on the safe side, though, I didn't do my morning or evening walk on Sunday. My blood sugar readings were still OK on Sunday.
But Monday, I was still spotting and again didn't go on my morning walk. That's when I started having higher blood sugar readings. Since the spotting was going away, I went on a short walk on Tuesday after breakfast. After a couple of days of not not walking, even my fasting levels were creeping up. They had been in the low to mid-90s. Three days in a row they were high 90s and I had one 100.
Gradually, by this last weekend, I was doing my full morning and evening walks and the last few days my numbers have been more like they used to be before the whole triage incident. It seems like there is a cumulative effect with the exercise - that first day of no exercise my numbers were still OK. And it took several days of resuming exercise before my numbers started to go down.
But since I had more than 6 post-meal levels above 130 in a week and more than 3 high fasting levels, I had to go see the dietitian again, a week earlier than scheduled.
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